Mental Health Care Power of Attorney - Statutory Form
Power of Attorney and Health Care - General - Arizona
36-3281. Mental health care power of attorney; scope; definition
A. An adult, known as the principal, pursuant to section 36-3282 may designate another adult or adults, known as the agent, to act as an agent and to make mental health care decisions on that person's behalf. The principal may also designate an alternate adult or adults to act as agent if the original designated agent or agents are unwilling or unable to act.
B. An agent under section 36-3283 may make decisions about mental health treatment on behalf of the principal if the principal is found incapable. If an adult does not have a mental health care power of attorney pursuant to this section, an agent with a health care power of attorney under section 36-3221 may make decisions about mental health treatment on behalf of the principal if the principal is found incapable, except as provided in section 36-3283, subsection F. These decisions shall be consistent with any wishes the principal has expressed in the mental health care directive, mental health care power of attorney, health care power of attorney or other advance directive.
C. An agent shall not be a person who is directly involved with the provision of health care to the principal at the time the mental health care power of attorney is executed.
D. For the purposes of this section, "incapable" means that in the opinion of a physician who is licensed pursuant to title 32, chapter 13 or 17 and who is a specialist in psychiatry or a psychologist who is licensed pursuant to title 32, chapter 19.1, a person's inability to give informed consent as defined in section 36-501.
36-3282. Execution requirements
A. To be valid, a mental health care power of attorney shall:
1. Be executed by a principal who is not incapable, as defined in section 32-3281.
2. Be in writing.
3. Contain language that clearly indicates that the principal intends to create a mental health care power of attorney.
4. Except as provided pursuant to subsection C of this section, be dated and signed or marked by the principal.
5. Be notarized or witnessed in writing by at least one adult who affirms that the notary or witness was present when the principal dated and signed or marked the mental health care power of attorney and that the principal appeared to be of sound mind and free from duress, fraud or undue influence at that time.
B. If a mental health care power of attorney expressly provides that the agent can admit the principal to a level one behavioral health facility licensed by the department of health services, each paragraph that grants this authority must be separately initialed by the principal at the time the mental health care power of attorney is signed and witnessed.
C. If the principal is physically unable to sign or mark a mental health care power of attorney, the notary and each witness shall verify on the document that the principal indicated to the notary or witness that the mental health care power of attorney expressed the principal's wishes and that the principal intended to adopt the mental health care power of attorney at that time.
D. A notary or witness shall not be any of the following:
1. A person designated to make medical decisions on the principal's behalf.
2. A professional care provider directly involved with the provision of care to the principal at the time the mental health care power of attorney is executed.
E. If a mental health care power of attorney is witnessed by only one person, that person shall not be either:
1. Related to the principal by blood, marriage or adoption.
2. Entitled to any part of the principal's estate by will or by operation of law at the time that the power of attorney is executed.
F. A mental health care power of attorney may be used as part of or independent of a health care power of attorney as defined in section 36-3201
36-3283. Powers and duties of an agent
A. An agent may make mental health care decisions for the principal while the principal is incapable, as defined in section 36-3281.
B. Except as limited by subsection F of this section, an agent's authority to make mental health care decisions is limited only by the express language of the mental health care power of attorney or by a court order pursuant to section 36-3206.
C. The appointment of a person to act as an agent is effective until that authority is revoked by the principal or by a court order.
D. An agent has the same right as the principal to receive information and to review the principal's medical records regarding proposed mental health treatment and to receive, review and consent to the disclosure of medical records relating to that treatment.
E. An agent shall act consistently with the wishes of the principal as expressed in the mental health care power of attorney. Except as limited by subsection F of this section, if the principal's wishes are not expressed in the mental health care power of attorney and are not otherwise known by the agent, the agent shall act in accordance with what the agent in good faith believes to be in the principal's best interests.
F. An agent may consent to admit the principal to a level one behavioral health facility licensed by the department of health services if this authority is expressly stated in the mental health care power of attorney or health care power of attorney under section 36-3221.
G. An agent is not subject to criminal or civil liability for decisions made in good faith and pursuant to a mental health care power of attorney or health care power of attorney.
A. A mental health care power of attorney is effective when it is executed and remains in effect until it is revoked by the principal pursuant to section 36-3285 or by court order.
B. If the mental health care power of attorney specifically authorizes the agent to admit the principal to a level one behavioral health facility, a principal shall not be admitted to a level one behavioral health facility licensed by the department of health services unless a physician who is licensed pursuant to title 32, chapter 13 or 17 and who is a specialist in psychiatry or a psychologist who is licensed pursuant to title 32, chapter 19.1 does all of the following:
1. Conducts an investigation that carefully probes the principal's psychiatric and psychological history, diagnosis and treatment needs.
2. Conducts a thorough interview with the principal and the agent.
3. Obtains the agent's informed consent, as defined in section 36-501.
4. Makes a written determination that the principal needs an inpatient evaluation or will benefit from care and treatment of a mental disorder or other personality disorder or emotional condition in the program and that the evaluation or treatment cannot be accomplished in a less restrictive setting.
5. Documents in the principal's medical chart a summary of the doctor's findings and recommendations for treatment.
C. The level one behavioral health facility licensed by the department of health services shall conduct a review of the principal's condition and need for admission into the facility and assess the appropriateness of the principal's placement at least once every thirty days. The agent may participate in each review. If possible the agent shall participate in person.
36-3285. Revocation; disqualification of agent
A. Unless limited by the express authority in the document, a principal even if incapable, as defined in section 36-3281, may revoke all or any part of the principal's mental health care power of attorney by doing any of the following:
1. Making a written revocation of the mental health care power of attorney or a written statement to disqualify an agent.
2. Orally notifying the agent or a mental health care provider.
3. Making a new mental health care power of attorney.
4. Any other act that demonstrates a specific intent to revoke a mental health care power of attorney or disqualify an agent.
B. Unless a facility has instituted proceedings pursuant to section 36-533, if a principal who is a patient in a mental health facility revokes a mental health care power of attorney and requests a discharge in writing, the facility shall discharge that person within twenty-four hours after it receives this request, excluding weekends and legal holidays. THE DISCHARGE REQUIREMENT PRESCRIBED IN THIS SECTION DOES NOT APPLY IF A MENTAL HEALTH CARE PROVIDER IS PROHIBITED FROM DISCHARGING THE PERSON UNDER FEDERAL LAW.
36-3286. Sample mental health care power of attorney
A person may use any writing that meets the requirements of sections 36-3281 and 36-3282 to create a mental health care power of attorney.
36-3287. Surrogate; mental health care power of attorney
The provisions of this chapter that relate to the powers and duties of surrogates apply to a mental health care power of attorney.
